Anemia, Neutropenia, Thrombocytopenia, & Pancytopenia in Oncology
Anemia
What is anemia?
Anemia is a condition in which the red blood cell (RBC) count in your blood is lower than normal. This is usually detected in a test called a complete blood count (CBC). This condition means that your blood also has a low amount of hemoglobin, which is part of the RBC, which is the part of the cell that carries the oxygen to the different parts of the body. Most of the time, most people do not feel any symptoms until their hemoglobin level is below normal levels (less than 11 g/dL).
These symptoms include:
Fast heartbeat
Shortness of breath
Trouble breathing when doing things like walking, climbing stairs, or even talking
Dizziness
Chest pain
Swelling in the hands and/or feet
Pale skin, nail beds, mouth and gums
Extreme tiredness (fatigue)
What causes anemia in cancer patients?
The most common causes of anemia in cancer patients and people in general include:
Cancer development/ cellular dysfunction
Cancer treatment (chemotherapy, radiation, others)
Blood loss (this can be slow constant bleeding such as from the intestine or bladder; or fast bleeding, like heavy menstruation or bleeding from a stomach ulcer)
Vitamins and minerals that the person is not eating in their diet.
Major organ problems (including severe heart, lung, kidney, or liver disease)
Red blood cells (RBCs) being destroyed by the body before they're replaced
The body making a lower amount of RBCs.
Inherited diseases such as Sickle cell disease or thalassemia
A combination of factors mentioned above.
In addition, if a patient is on platinum-based chemotherapy, certain tumors (like ovarian or lung tumors), and having a low hemoglobin prior to the cancer, makes them at risk to becoming anemic.
How does anemia affect cancer?
If your doctor or nurse suspects that you may be at risk for anemia, they will be observing your signs and symptoms, as well as monitoring your hemoglobin levels. Other things that they will look at to figure out your risk for getting this condition includes your hemoglobin levels and other lab results, past cancer treatments, blood transfusions in the past 6 months, any lung, heart, or circulation problems, and your age. If you have severe anemia, it may delay your cancer treatment or make the dose of your treatment have to be reduced. It can also cause them not to work as well as they are expected to.
How is anemia treated?
Depending on the cause, the treatment can be different. Treatments include:
Eating nutrient-rich foods
Taking iron and folic acid supplements
RBC transfusion
Take medications that will make your body create more RBCs (Epoetin and Darbepoetin)
Neutropenia
What is Neutropenia?
Neutrophils are a type of white blood cell (WBC) that flows through your blood stream, and helps fight off infection. Neutropenia is an abnormally low amount of these kinds of cells. People that have this kind of condition have a higher risk of infection since they do not have as many cells fighting off harmful microorganisms. Symptoms that a person with this condition may feel include:
Fever
Chills/ sweating
Sore throat or mouth sores
Pain in the abdomen
Diarrhea (sores around the anus as well)
Painful, burning, or frequent urination
Cough
Shortness of breath
Signs of infection around a cut, wound, or IV site
Unusual vaginal discharge or itching
What are the causes of Neutropenia in cancer patients?
Cancer and cancer treatment can cause neutropenia in many ways. Some kinds of chemotherapy effect the bone marrow, making it produce lower amounts of neutrophils. Also, different kinds of cancers (leukemia, lymphoma, and myeloma, or metastatic cancer) that make the bone marrow produce abnormal amounts of blood cells and crowd the bone marrow’s normal cells. Radiation therapy can also affect the bone marrow of a cancer patient. Also, if the patient is older, they run the risk of getting this condition since their immune system is already weakened.
How can neutropenia in cancer patients be treated?
If the patient’s bone marrow does not return to developing normal levels of neutrophils after chemotherapy, the doctor may delay the next round of chemotherapy, or lower the next dose. Also, the doctor may prescribe some antibiotics if the patient is going to be experiencing long periods of time with neutropenia, so that their risk for infection can be decreased. If chemotherapy causes neutropenia and the patient has a fever, the doctor may decide to prescribe medications that increase the neutrophils and other WBC production, which includes Filgrastim, Pegfilgrastim, or Sargramostim.
Thrombocytopenia
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What is thrombocytopenia?
Thrombocytopenia is a bleeding disorder in which the body contains a lower than normal number of functional platelets. It is the most common cause of bleeding in cancer patients. Platelet levels may decline as a result of:
- Insufficient bone marrow production of platelets - Increased consumption of platelets - Abnormal platelet removal from the blood by the spleen
Platelets play an important role in the clotting mechanism of blood, which allows the body to control bleeding at the site of injury. When tissue injury occurs, the blood vessel slows bloodflow past the site of the wound. Platelets then collect at at the site of injury to form a plug. This platelet plug is then replaced by a coagulation protein called fibrin, which forms a clot and allows for healing of the wound to take place.
Platelets are produced in the bone marrow and are removed from the blood by the spleen. These two organs must work together to regulate platelet levels in the blood. Due to platelet cell fragility, they are easily damaged in many disorders, and especially vulnerable in bone marrow diseases. In cancer patients, thrombocytopenia may result from the presence of the tumor or may occur in response to the chemotherapy or radiation used in treatment. Generally, symptoms do not occur until platelets are very low.
Signs & symptoms include:
- Unexpected bruising - Petechiae, which are small, red-purple pinpoint hemorrhages on the surface of skin - Bleeding from the nose or gums - Heavy menstrual periods in women - Black or bloody stools - Hematuria - Severe headaches - Dizziness - Painful joints or muscles - Weakness
What are the causes of thrombocytopenia in cancer patients?
Thrombocytopenia may be due to insufficient platelet production or to platelet destruction in the blood or spleen. Platelet production in the bone marrow may be suppressed by leukemia, aplastic anemia, burns, cancer chemotherapy, exposure to radiation used in cancer treatment, HIV virus, and nutritional deficiencies, among others. More relative to oncology patients, thrombocytopenia can result due to:
- Some types of chemotherapy can damage bone marrow, resulting in decreased ability to make a sufficient number of platelets. - Autoimmune processes; production of antibodies by the person's body, resulting in platelet destruction. - Cancer cells (such as leukemia or lymphoma cells) crowd normal bone marrow cells. - Cancer mestasis to the bone marrow (i.e. Breast cancer) - Cancer of the spleen (although uncommon) can cause increased platelet destruction, by the invasion of cancer cells into the organ, disrupting normal platelet activity. How is thrombocytopenia in cancer patients treated?
The first step to treatment of thrombocytopenia is determination of the underlying cause for the low platelet count. Routine blood draws will be done to diagnose and manage care. A reduction in the chemotherapy or radiation dose/frequency may require adjustment to allow for platelet level to return to normal. Any scheduled surgeries are delayed until platelets are restored to a normal level. Patient may require a platelet transfusion. However, those receiving chemotherapy may be prescribed certain drugs to prevent severe thrombocytopenia, in addition to reducing the need for platelet transfusions.
Nursing Precautions: - Routinely monitor client for evidence of hemorrhage. - Institute fall precautions in those who are at increased risk for falls to reduce injuries. - Elevate client HOB at least 30 degrees and maintain client on bedrest during thrombocytic episode. - Observe patient for chills, rigors, fever, or allergic reactions. - Treat patient with acetaminophen or diphenhydramine to prevent platelet transfusion reactions. - Apply pressure to sites of venipuncture/IV access for 20 minutes. - Have patient use soft toothbrush or spongestick for oral care, blade-less electric razor. - Discourage patient from straining/coughing; treat symptoms as needed with PRN antiemetics, cough suppressants, etc. - Avoid aspirin and NSAIDS. (Also certain herbs; feverfew, gingko, ginseng, kava) - Corticosteroids, immunoglobulin, or gamma globulin therapy may be prescribed to decrease platelet destruction in immune-mediated thrombocytopenia. - Folate may stimulate bone marrow production of platelets in those with folate deficiency - Pt may undergo splenectomy to decrease platelet destruction in some cases
Where can I find more information on managing my thrombocytopenia?
Pancytopenia
What is pancytopenia? Pancytopenia is a reduction in ALL types of cellular elements of the blood at one time; whereas, solitary cell-type deficiencies occurring individually are classified accordingly.
These cellular components include: - Red Blood Cells: Anemia (Hemoglobin < 13.5 g/dL in males, or < 12 g/dL in females) - White Blood Cells: Neutropenia (Absolute Neutrophil Count < 1.5×103/microliter) - Platelets: Thrombocytopenia (Platelet count <150×109/L)
Pancytopenia occurs when your body cannot produce enough blood cells due to dysfunction of the bone marrow stem cells, which form RBC, WBC, & platelets. This condition has widespread effects on the entire body as a whole, including complications of decreased oxygen, as well as dysfunction of the immune system. Aplastic Anemia is a medical term that refers to the decrease in production of all types of blood cells. Pancytopenia occurs in two forms: - Idiopathic/Autoimmune: (Most common) Body attacks it's own tissues, recognizing them as foreign invaders - Secondary: Caused by environmental factors *Pancytopenia can also be caused by viral infections, radiation or chemotherapy treatments, drug reactions, and exposure to toxins.
Signs & Symptoms are related to the functions of each deficient cellular element collectively: - Bleeding, easy bruising, fatigue, shortness of breath, and weakness (r/t low RBC & platelet levels) - Increased risk of infection (r/t low WBC counts)
What are some causes of pancytopenia in cancer patients? Some causes of pancytopenia (in oncology): - Leukemia - Treatments, such as chemotherapy and radiation
How is pancytopenia in cancer patients typically treated?
Treatment of pancytopenia is dependent upon the cause of the deficiencies.
Some treatment options include:
- Immunosuppressant drugs: Prevents destruction of these cells by the immune system. - Bone marrow stimulants: Encourages increased activity of bone marrow to create more RBC, WBC, & platelets. - Blood transfusions: Replaces the severe deficiencies in any particular blood component. - Bone marrow transplant: Functioning marrow from a donor, to correct deficiencies. - Stem cell replacement therapy: Restores function of bone marrow stem cells in production of cellular elements
Are there any up-to-date informative articles available on this topic?
Article: "Development of Pancytopenia with Neutralizing Antibodies to Thrombopoietin After Multicycle Chemotherapy Supported by Megakaryocyte Growth and Development Factor" http://bloodjournal.hematologylibrary.org/content/99/7/2599.full Journal of the American Society of Hematology. "Blood: Leading the World in Reporting Basic and Applied Hematology" (research doi: 10.1182/blood.V99.7.2599 Blood April 1, 2002 vol. 99 no. 7 2599-2602)
Where can I find more information about managing my pancytopenia?
Anemia, Neutropenia, Thrombocytopenia, & Pancytopenia in Oncology
Anemia
What is anemia?Anemia is a condition in which the red blood cell (RBC) count in your blood is lower than normal. This is usually detected in a test called a complete blood count (CBC). This condition means that your blood also has a low amount of hemoglobin, which is part of the RBC, which is the part of the cell that carries the oxygen to the different parts of the body. Most of the time, most people do not feel any symptoms until their hemoglobin level is below normal levels (less than 11 g/dL).
These symptoms include:
What causes anemia in cancer patients?
The most common causes of anemia in cancer patients and people in general include:
In addition, if a patient is on platinum-based chemotherapy, certain tumors (like ovarian or lung tumors), and having a low hemoglobin prior to the cancer, makes them at risk to becoming anemic.
How does anemia affect cancer?
If your doctor or nurse suspects that you may be at risk for anemia, they will be observing your signs and symptoms, as well as monitoring your hemoglobin levels. Other things that they will look at to figure out your risk for getting this condition includes your hemoglobin levels and other lab results, past cancer treatments, blood transfusions in the past 6 months, any lung, heart, or circulation problems, and your age. If you have severe anemia, it may delay your cancer treatment or make the dose of your treatment have to be reduced. It can also cause them not to work as well as they are expected to.
How is anemia treated?
Depending on the cause, the treatment can be different.
Treatments include:
Neutropenia
What is Neutropenia?
Neutrophils are a type of white blood cell (WBC) that flows through your blood stream, and helps fight off infection. Neutropenia is an abnormally low amount of these kinds of cells. People that have this kind of condition have a higher risk of infection since they do not have as many cells fighting off harmful microorganisms.
Symptoms that a person with this condition may feel include:
What are the causes of Neutropenia in cancer patients?
Cancer and cancer treatment can cause neutropenia in many ways. Some kinds of chemotherapy effect the bone marrow, making it produce lower amounts of neutrophils. Also, different kinds of cancers (leukemia, lymphoma, and myeloma, or metastatic cancer) that make the bone marrow produce abnormal amounts of blood cells and crowd the bone marrow’s normal cells. Radiation therapy can also affect the bone marrow of a cancer patient. Also, if the patient is older, they run the risk of getting this condition since their immune system is already weakened.
How can neutropenia in cancer patients be treated?
If the patient’s bone marrow does not return to developing normal levels of neutrophils after chemotherapy, the doctor may delay the next round of chemotherapy, or lower the next dose. Also, the doctor may prescribe some antibiotics if the patient is going to be experiencing long periods of time with neutropenia, so that their risk for infection can be decreased. If chemotherapy causes neutropenia and the patient has a fever, the doctor may decide to prescribe medications that increase the neutrophils and other WBC production, which includes Filgrastim, Pegfilgrastim, or Sargramostim.
Thrombocytopenia
==
What is thrombocytopenia?
Thrombocytopenia is a bleeding disorder in which the body contains a lower than normal number of functional platelets. It is the most common cause of bleeding in cancer patients.
Platelet levels may decline as a result of:
- Insufficient bone marrow production of platelets
- Increased consumption of platelets
- Abnormal platelet removal from the blood by the spleen
Platelets play an important role in the clotting mechanism of blood, which allows the body to control bleeding at the site of injury. When tissue injury occurs, the blood vessel slows bloodflow past the site of the wound. Platelets then collect at at the site of injury to form a plug. This platelet plug is then replaced by a coagulation protein called fibrin, which forms a clot and allows for healing of the wound to take place.
Platelets are produced in the bone marrow and are removed from the blood by the spleen. These two organs must work together to regulate platelet levels in the blood. Due to platelet cell fragility, they are easily damaged in many disorders, and especially vulnerable in bone marrow diseases. In cancer patients, thrombocytopenia may result from the presence of the tumor or may occur in response to the chemotherapy or radiation used in treatment.
Generally, symptoms do not occur until platelets are very low.
Signs & symptoms include:
- Unexpected bruising
- Petechiae, which are small, red-purple pinpoint hemorrhages on the surface of skin
- Bleeding from the nose or gums
- Heavy menstrual periods in women
- Black or bloody stools
- Hematuria
- Severe headaches
- Dizziness
- Painful joints or muscles
- Weakness
What are the causes of thrombocytopenia in cancer patients?
Thrombocytopenia may be due to insufficient platelet production or to platelet destruction in the blood or spleen. Platelet production in the bone marrow may be suppressed by leukemia, aplastic anemia, burns, cancer chemotherapy, exposure to radiation used in cancer treatment, HIV virus, and nutritional deficiencies, among others. More relative to oncology patients, thrombocytopenia can result due to:
- Some types of chemotherapy can damage bone marrow, resulting in decreased ability to make a sufficient number of platelets.
- Autoimmune processes; production of antibodies by the person's body, resulting in platelet destruction.
- Cancer cells (such as leukemia or lymphoma cells) crowd normal bone marrow cells.
- Cancer mestasis to the bone marrow (i.e. Breast cancer)
- Cancer of the spleen (although uncommon) can cause increased platelet destruction, by the invasion of cancer cells into the organ, disrupting normal platelet activity.
How is thrombocytopenia in cancer patients treated?
The first step to treatment of thrombocytopenia is determination of the underlying cause for the low platelet count. Routine blood draws will be done to diagnose and manage care. A reduction in the chemotherapy or radiation dose/frequency may require adjustment to allow for platelet level to return to normal. Any scheduled surgeries are delayed until platelets are restored to a normal level. Patient may require a platelet transfusion. However, those receiving chemotherapy may be prescribed certain drugs to prevent severe thrombocytopenia, in addition to reducing the need for platelet transfusions.
Nursing Precautions:
- Routinely monitor client for evidence of hemorrhage.
- Institute fall precautions in those who are at increased risk for falls to reduce injuries.
- Elevate client HOB at least 30 degrees and maintain client on bedrest during thrombocytic episode.
- Observe patient for chills, rigors, fever, or allergic reactions.
- Treat patient with acetaminophen or diphenhydramine to prevent platelet transfusion reactions.
- Apply pressure to sites of venipuncture/IV access for 20 minutes.
- Have patient use soft toothbrush or spongestick for oral care, blade-less electric razor.
- Discourage patient from straining/coughing; treat symptoms as needed with PRN antiemetics, cough suppressants, etc.
- Avoid aspirin and NSAIDS. (Also certain herbs; feverfew, gingko, ginseng, kava)
- Corticosteroids, immunoglobulin, or gamma globulin therapy may be prescribed to decrease platelet destruction in immune-mediated thrombocytopenia.
- Folate may stimulate bone marrow production of platelets in those with folate deficiency
- Pt may undergo splenectomy to decrease platelet destruction in some cases
Where can I find more information on managing my thrombocytopenia?
Pancytopenia
Pancytopenia is a reduction in ALL types of cellular elements of the blood at one time; whereas, solitary cell-type deficiencies occurring individually are classified accordingly.
These cellular components include:
- Red Blood Cells: Anemia (Hemoglobin < 13.5 g/dL in males, or < 12 g/dL in females)
- White Blood Cells: Neutropenia (Absolute Neutrophil Count < 1.5×103/microliter)
- Platelets: Thrombocytopenia (Platelet count <150×109/L)
Pancytopenia occurs when your body cannot produce enough blood cells due to dysfunction of the bone marrow stem cells, which form RBC, WBC, & platelets. This condition has widespread effects on the entire body as a whole, including complications of decreased oxygen, as well as dysfunction of the immune system.
Aplastic Anemia is a medical term that refers to the decrease in production of all types of blood cells.
Pancytopenia occurs in two forms:
- Idiopathic/Autoimmune: (Most common) Body attacks it's own tissues, recognizing them as foreign invaders
- Secondary: Caused by environmental factors
*Pancytopenia can also be caused by viral infections, radiation or chemotherapy treatments, drug reactions, and exposure to toxins.
Signs & Symptoms are related to the functions of each deficient cellular element collectively:
- Bleeding, easy bruising, fatigue, shortness of breath, and weakness (r/t low RBC & platelet levels)
- Increased risk of infection (r/t low WBC counts)
What are some causes of pancytopenia in cancer patients?
Some causes of pancytopenia (in oncology):
- Leukemia
- Treatments, such as chemotherapy and radiation
How is pancytopenia in cancer patients typically treated?
Treatment of pancytopenia is dependent upon the cause of the deficiencies.
Some treatment options include:
- Immunosuppressant drugs: Prevents destruction of these cells by the immune system.- Bone marrow stimulants: Encourages increased activity of bone marrow to create more RBC, WBC, & platelets.
- Blood transfusions: Replaces the severe deficiencies in any particular blood component.
- Bone marrow transplant: Functioning marrow from a donor, to correct deficiencies.
- Stem cell replacement therapy: Restores function of bone marrow stem cells in production of cellular elements
Are there any up-to-date informative articles available on this topic?
Article:
"Development of Pancytopenia with Neutralizing Antibodies to Thrombopoietin After Multicycle Chemotherapy Supported by Megakaryocyte Growth and Development Factor"
http://bloodjournal.hematologylibrary.org/content/99/7/2599.full
Journal of the American Society of Hematology. "Blood: Leading the World in Reporting Basic and Applied Hematology" (research doi: 10.1182/blood.V99.7.2599 Blood April 1, 2002 vol. 99 no. 7 2599-2602)
Where can I find more information about managing my pancytopenia?
Resources:
http://www.cancer.org/Treatment/TreatmentsandSideEffects/PhysicalSideEffects/Anemia/anemia-in-people-with-cancer
http://www.mayoclinic.com/health/anemia/DS00321
http://www.cancer.net/patient/All+About+Cancer/Treating+Cancer/Managing+Side+Effects/Neutropenia
www.nlm.nih.gov/medlineplus/ (U.S. National Library of Medicine)
www.cancer.org (American Cancer Society)